EIZO / Warranty

Extended Service Warranty Claim Form (State health departments only)

If you are reading this it is because we are administering a warranty repair claim on your original EIZO Monitor/graphics card. Please accept our apologies for any inconvenience you are experiencing as a result of this equipment failure. Your co-operation in completing and returning this simple form will enable us to start on the solution right away.

BUSINESS HOURS SUPPORT: Tel: +61 (0)2 9462 7500
AFTER HOURS SUPPORT: +61 (0) 421 700 602

Usage Time information can be found in the screen manager menu under "information" (3rd screen)

NB. Please do not use this form if you do not have 365day support stipulated under contract

Fields marked with the asterisk * are mandatory.

Your Details
*Company name:
*Contact Person:
Reseller (if any):
*Contact Phone Number:
*Email Address:
*Delivery Address 1:
Delivery Address 2:
*State/Territory:
*Postcode:
Country:	Australia New Zealand

Claim Details
*Model name:
*Serial Number:
*Invoice Number:
*Purchase Date:	(DD/MM/YYYY)
*Usage Time(hrs):
Defect Occurred Date:	(DD/MM/YYYY)

Frequency of Fault:	Always Sometimes Begin use When time passes At specific operation
Nature of Defect:
Environment	(mandantory for Graphics card)
Computer:
OS:
Board driver:
Monitor:
Resolution(e.g., 1280 x 1024) :
	Please check the information you enter before clicking submit.